Inspection on 23/02/06 for Newgate Street, 67

This inspection was carried out on 23rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Newgate Street, 67 21/07/08

Newgate Street, 67 03/07/07

Newgate Street, 67 06/07/06

Newgate Street, 67 19/08/05

Newgate Street, 67 13/12/04

Newgate Street, 67 14/09/04

Newgate Street, 67 25/03/04

Similar services:

Craigmore House

1 Lanark Close

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Newgate Street, 67 67 Newgate Street Morpeth Northumberland NE61 1AY Lead Inspector Anne Brown Unannounced Inspection 24th February 2006 09:30 DS0000000562.V258336.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000000562.V258336.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000000562.V258336.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Newgate Street, 67 Address 67 Newgate Street Morpeth Northumberland NE61 1AY 01670 512482 01670 512482 newgatemorpeth@fsmail.net Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Northgate & Prudhoe NHS Trust Mrs Julia Marley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000000562.V258336.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th August 2005 Brief Description of the Service: 67 Newgate Street is a small residential care home offering accommodation for three male adults with learning disabilities. It is registered to provide personal care, but not nursing care. It is a two-storey terraced house in the centre of Morpeth, close to all facilities and transport networks. There are three single bedrooms on the first floor and two lounges and a dining kitchen downstairs. There is no lift available to the first floor. There is a small garden and patio area to the rear of the premises. DS0000000562.V258336.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over five hours. A tour of the premises was carried out and the care records were inspected along with the fire logbook, accident book, complaints records and minutes of meetings held in the home. Discussions were held with the two members of staff. A further visit was made to speak with the service users. The Manager was off duty on the day of this inspection and a further visit was made to discuss the inspection with her. What the service does well: What has improved since the last inspection? Since the last inspection the service users now sign their own bank account transactions. DS0000000562.V258336.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000000562.V258336.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000000562.V258336.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: DS0000000562.V258336.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. Service users are well supported by staff and the necessary levels of support are provided. Detailed care plans show the level of care and support that staff need to provide. Comprehensive risk assessments are carried out to assist service users to lead as fulfilled lives as possible and they are well supported by staff to take calculated risks as necessary. EVIDENCE: The care plans were examined and they contained a great deal of detailed information about the personal, social and health care needs of the service users. However the monthly evaluations were out of date. The manager was aware of this and intends to update them in the next few weeks. Care plans were written but were not necessarily in an accessible format for service users to understand and to have any ownership of them. DS0000000562.V258336.R01.S.doc Version 5.0 Page 10 Service users are encouraged to be involved in decision-making and they are encouraged to communicate and make their views known. Meetings are held regularly and their minutes recorded. Risk assessments are carried out and there was evidence to show that the staff support the service users to take risks to encourage independence in their everyday lives. However risk assessments had not been reviewed since October 2004. DS0000000562.V258336.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 17. Links with the community and opportunities to participate in social and personal development activities have been good, but of late have reduced which means residents have had few opportunities to mix with other people and participate in worthwhile activities. Meals are varied and healthy eating is encouraged. EVIDENCE: Discussion with the staff and examination of records showed that service users have been supported to use a variety of facilities in the community. However, it also seems that there has been a decline in the opportunities for service users to go out and on holiday. There were a number of entries in the minutes of the service users’ meetings indicating they had asked to go on holiday and to the Edinburgh Tattoo but due to staff shortages this had not been possible. The staff on duty agreed that outdoor activities had reduced and that this was due to only one member of staff being on duty. They felt they needed more DS0000000562.V258336.R01.S.doc Version 5.0 Page 12 staff to provide the support that individual service users need and ensure their safety. Service users are asked their choice of evening meal every morning. The service users confirmed that the food was very good and mealtimes were flexible. They accompany the staff on shopping trips and enjoy take away meals of their choice on a regular basis. Records are kept of the food that is served. DS0000000562.V258336.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. The staff team are fully informed and provide personal support to the service users in the way they prefer. There are excellent arrangements in place to ensure that residents’ health care needs are met. An appropriate system is in place for dealing with medications. EVIDENCE: The case records contained relevant individual plans of care detailing care and support required for individual needs. Records were in place to confirm that service users had seen health professionals when required. Service users are assisted to access dental and optical services at least annually or as often as required. The medication records and the system for storage and handling of medication was looked at and found to be appropriate. A book is kept to record when medications are ordered and received into the home. However some medications had been recorded as received, but there was no record of them being ordered. The records were unclear and has caused some confusion for the staff. DS0000000562.V258336.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. There is a suitable complaints procedure. Service users and their relatives have confidence that they can raise any issues and know that they will be dealt with. The home’s management team have a sound grasp of Protection of Vulnerable procedures. EVIDENCE: The home has a complaints procedure. There have been no complaints about the home since the last inspection. A procedure for responding to allegations of abuse is available. Staff have received training in Adult Protection. DS0000000562.V258336.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The building is comfortable and generally well maintained with good quality furnishings and décor. There is an excellent standard of hygiene. EVIDENCE: The building is full of character and homely. There is ample space for service users to enjoy internally and there is a small garden externally. Service users have their own bedrooms that are personalized to their own taste. The stair carpet is threadbare in places which could be a safety hazard. There are adequate laundry facilities in place and staff receive training about infection control. DS0000000562.V258336.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 36. The agreed staffing levels required to meet the needs of the current service users have not been met on all occasions which has led to service users having fewer opportunities to enjoy activities outside of the home. Staff supervision sessions are not up to date. EVIDENCE: Two staff members are required to be on duty to enable the service users to enjoy individual activities outside the home. The duty rotas showed that staffing levels had not been met at required times during February and March. The manager stated that two new staff members had recently been appointed to ensure staffing levels are met. Staff receive induction training. Where new inexperienced staff are employed, they work as an extra member of the shift, which is good practice. The manager is aware that formal staff supervision sessions were out of date and stated these would be carried out as soon as possible. Staff meetings have not been held on a monthly basis. DS0000000562.V258336.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42. Service users are fully involved and at the heart of decision making in their own lives and involved in the running of the home. Systems and procedures are in place to ensure the well running of the home and to ensure the safety of residents and staff. EVIDENCE: Service users meetings take place on a regular basis. Minutes were available for inspection. The service users confirmed that they are asked their opinions on the running of the home. There is a system in place to ensure that the staff are trained in moving and handling skills, fire safety, first aid, infection control and food hygiene. The fire logbook indicated that the fire alarm had not been routinely tested on a weekly basis. DS0000000562.V258336.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 2 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 X DS0000000562.V258336.R01.S.doc Version 5.0 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(2)(b) Timescale for action Care plans must be reviewed and 30/04/06 evaluated on a regular basis. (Previous timescale of 19/10/05 not met) Risk assessments must be 31/03/06 reviewed and updated. Service users must be provided 30/04/06 with necessary support to participate in activities of their choice. System for ordering and 03/03/06 recording medications must be reviewed. Staffing levels must meet the 31/03/06 assessed needs of the service users. Formal supervision sessions for 30/04/06 staff must be brought up to date. Fire alarm checks must be 03/03/06 carried out and recorded on a weekly basis. Requirement 2 3 YA9 YA14 13(4)(b) and (c) 16(2)(m) 4 5 6 7 YA20 YA35 YA36 YA42 13(2) 18(1)(a) 18(2) 23(4)(c) DS0000000562.V258336.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 1 Refer to Standard YA6 YA24 Good Practice Recommendations Care plans to be in an accessible format for all service users to understand. Stair carpet to be renewed. DS0000000562.V258336.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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